Grado G L, Collins J M, Kriegshauser J S, Balch C S, Grado M M, Swanson G P, Larson T R, Wilkes M M, Navickis R J
Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA.
Urology. 1999 Jan;53(1):2-10. doi: 10.1016/s0090-4295(98)00492-0.
To evaluate the effectiveness and morbidity of salvage brachytherapy for locally recurrent or persistent prostate cancer after radiotherapy failure.
In this retrospective study, 49 patients of median age 73.3 years (range 52.9 to 86.9) with biopsy-proven localized prostate cancer underwent interactive transperineal fluoroscopic-guided and biplane ultrasound-guided brachytherapy with either iodine 125 or palladium 103 after prior radiotherapy failure. Post-treatment follow-up was conducted for a median of 64.1 months (range 26.6 to 96.8) and included clinical assessment of disease status, assays of serum prostate-specific antigen (PSA) levels, and documentation of treatment-related symptoms and complications. Determination of biochemical treatment failure was based on two successive rising PSA values above the post-treatment PSA nadir value.
The actuarial rate of local prostate cancer control was 98% (95% confidence interval [CI] 94% to 99%). Actuarial disease-specific survival at 3 and 5 years was 89% (95% CI 73% to 96%) and 79% (95% CI 58% to 91%), respectively. At 3 and 5 years, actuarial biochemical disease-free survival was 48% (95% CI 32% to 63%) and 34% (95% CI 17% to 51%), respectively. Post-treatment PSA nadir was found to be a significant predictor of biochemical disease-free survival. Actuarial biochemical disease-free survival of patients who achieved a PSA nadir less than 0.5 ng/mL was 77% (95% CI 53% to 90%) and 56% (95% CI 25% to 78%) at 3 and 5 years, respectively. Of 49 patients, 23 (47%) achieved a post-treatment PSA nadir less than 0.5 ng/mL. The incidence of serious complications after salvage brachytherapy, such as incontinence and rectal complications, was lower than that reported after other types of salvage procedures.
Interactive transperineal fluoroscopic-guided and biplane ultrasound-guided brachytherapy is a novel, potentially curative salvage modality for patients in whom prior radiotherapy failed. In a population of patients with poor prognosis, this modality was associated with a high rate of local prostate cancer control and a 34% actuarial rate of biochemical disease-free survival at 5 years. The incidence of major complications after salvage brachytherapy appears to be lower than that after other potentially curative salvage procedures, such as radical prostatectomy and cryoablation. Salvage brachytherapy warrants further investigation.
评估挽救性近距离放射治疗对放疗失败后局部复发或持续性前列腺癌的有效性及发病率。
在这项回顾性研究中，49例经活检证实为局限性前列腺癌的患者，中位年龄73.3岁（范围52.9至86.9岁），在先前放疗失败后，接受了经会阴交互式荧光镜引导及双平面超声引导下的碘125或钯103近距离放射治疗。治疗后中位随访64.1个月（范围26.6至96.8个月），包括疾病状态的临床评估、血清前列腺特异性抗原（PSA）水平检测以及治疗相关症状和并发症的记录。生化治疗失败的判定基于连续两次PSA值高于治疗后PSA最低点值。
前列腺癌局部控制的精算率为98%（95%置信区间[CI] 94%至99%）。3年和5年的精算疾病特异性生存率分别为89%（95% CI 73%至96%）和79%（95% CI 58%至91%）。3年和5年的精算无生化疾病生存率分别为48%（95% CI 32%至63%）和34%（95% CI 17%至51%）。发现治疗后PSA最低点是无生化疾病生存的显著预测因素。PSA最低点小于0.5 ng/mL的患者，3年和5年的精算无生化疾病生存率分别为77%（95% CI 53%至90%）和56%（95% CI 25%至78%）。49例患者中，23例（47%）治疗后PSA最低点小于0.5 ng/mL。挽救性近距离放射治疗后严重并发症（如尿失禁和直肠并发症）的发生率低于其他类型挽救性手术报告的发生率。
经会阴交互式荧光镜引导及双平面超声引导下的近距离放射治疗是一种新型的、对先前放疗失败患者有潜在治愈可能的挽救性治疗方式。在预后较差的患者群体中，这种治疗方式与较高的前列腺癌局部控制率以及5年34%的精算无生化疾病生存率相关。挽救性近距离放射治疗后主要并发症的发生率似乎低于其他潜在治愈性挽救手术（如根治性前列腺切除术和冷冻消融术）后的发生率。挽救性近距离放射治疗值得进一步研究。
